Generalized periodontitis is a medical and social problem – the disease is characterized by polysystemic changes that create the conditions for the formation and development of inflammatory process in periodontal tissues. It is important to plan a comprehensive treatment of patients with generalized periodontitis, especially the improvement of methods aimed at restoring lost bone fragments of the periodontal complex.
The aim of the study is to increase the effectiveness of treatment of exacerbated and aggressive (rapidly progressing) periodontitis by correcting the identified pathogenetic links of these variants of the inflammatory-destructive process in the periodontium using systemic enzyme therapy and recombinant osteoinductive drug.
Universal drugs include new generation enzymes that exhibit anti-inflammatory, dehydration, antitoxic, immunomodulatory and antioxidant effects, activation of microcirculatory and metabolic processes and the quality of tissue regeneration in areas of surgical and traumatic injuries. Bone morphological proteins (BMPs) are also increasingly used to increase osteoinductive effect.
We observed 123 patients, who were divided into four groups: the comparison group - 62 people (groups I and II ( by 31 people)) with exacerbated course, group III - 31 people and group IV - 30 patients with aggressive chronic generalized periodontitis.
Group I patients received traditional therapy, group II - traditional therapy in combination with systemic enzyme therapy "Wobenzyme". Group III patients received combined immunosuppressive therapy, antioxidant therapy ("Mexidol") and osteoinductive drug "Osteogenon". Patients of group IV (30 people) together with traditional and professional hygienic measures and combined antibacterial therapy were prescribed the drug "Wobenzym" and the drug rhBMP-2. When forming groups, we wanted compared them by age and sex and the severity of the disease. The control group (20 people) included volunteer donors of approximately the same age and sex.
At the time of the study, the duration of chronic generalized periodontitis, prone to permanent exacerbations of the inflammatory process in periodontal tissues, ranged from 4 to 6 years, and rapidly progressing generalized periodontitis – from 2 to 3 years.
In patients suffering from rapidly progressing periodontitis, a decrease in bone density in the alveolar processes was observed in 100% of subjects in the range of 300 units. and below (on average 278.4 ± 9.7 units), patients with an exacerbation course - only 12.9% of patients. At the same time, the Hounsfield index was not registered less than 300 units. (average 446.8 ± 11 units), with the norm (522.9 ± 16.4 units, p <0.05). Thus, the high specificity of dental volumetric computed tomography has determined the fact that the criterion of the Hounsfield index can be used to clarify the diagnosis and course of generalized periodontitis.
The presence of correlations between the activity of the destructive process in the periodontium and the levels of cytokines IL-1β, TNF-α markers of osteoresorption and osteosynthesis, as well as the concentration of superoxide dismutase (r = 0.72; r = 0.63; r = 0.32; r = 0.51; p <0.001). Direct correlations of levels of markers of osteoresorption (β-CL) and osteoblastogenesis (osteocalcin) with levels of proinflammatory cytokines in oral fluid (r = 0.69; p <0.001) were noted.
Comparative analysis of the dynamics of changes in SIgA values showed that after completion of treatment there was a significant increase in its levels in the oral fluid to the limits of the norm in both patients of group III and group IV (respectively 1.16 ± 0.5 g / l; p <0.05). Similar dynamics was observed in terms of IgM and IgG in patients of both groups. Against the background of normalization of SIgA, IgG and IgM levels of IgA in the oral fluid in patients of group IV after treatment did not change (p <0,05), and in patients of group III had a tendency to a significant decrease (p <0,05) to conditional norm.
The final analysis showed that in the group of patients with rapidly progressing generalized periodontitis who received "Wobenzyme" and rhBMP-2 (group IV), the average marker of resorption of β-CL after treatment decreased by 3.1 times, and osteocalcin – increased by 2 times and had a significant difference from the levels of the group of patients treated by the advanced traditional method (p <0.05).
The data obtained as a result of the research allow to expand the understanding of the pathogenic links that determine the various manifestations of the destructive process in the periodontium, to establish the causal factors that accelerate the rate of loss of periodontal bone tissue: excessive excess of IL-1β and TNF-α production, activation of lipid radical oxidation processes, decrease in the activity of antioxidant defense enzymes and significant separation of bone remodeling mechanisms due to enhanced bone resorption and reduced bone formation.
